Saint Francis Cancer Center / Natalie Warren Bryant Cancer Center Annual Report | 2014

2014 Annual Report Natalie Warren Bryant Cancer Center Saint Francis Cancer Center

together, we can.

together, we will.

Since 1975, the Natalie Warren Bryant Cancer Center, a part of Saint Francis Health System, has provided state-of-the-art medical oncology and radiotherapy technology to residents in eastern Oklahoma and surrounding states.

Committed to advancing oncology care, Saint Francis provides an array of oncology services to meet patient needs. The cancer center’s treatment practices include board-certified physicians who provide multidisciplinary care in a professional, patient- and family-focused setting.

Additionally, the cancer center is accredited by the American College of Surgeons as a Comprehensive Community Cancer Program and receives National Cancer Institute support for its ongoing efforts in oncology research, treatment and community education.

1

Cancer Committee Chairman Report

As a Comprehensive Community Cancer Program accredited by the American College of Surgeons Commission on Cancer (CoC) since 1978, Saint Francis Cancer Committee has been dedicated to improving patient care. To ensure our patients receive the highest quality of care, our on-site case management hours have been expanded to facilitate a more timely patient discharge process.

We have added a dedicated Financial Assistance Counselor who works directly with patients to find programs that assist them with any out-of-pocket costs they encounter during treatment. As of July 2014, over $63,000 in drug co-pay assistance has been obtained for oncology patients and $120,000 of drug replacement costs has been approved for self-pay patients receiving chemotherapy or injection services.

Saint Francis offers several screening and prevention programs that are available to the community.

Our Lung Screening Program is the first and only program in Oklahoma that has been recognized by the Lung Cancer Alliance as a Center of Excellence.

Saint Francis Health Zone offers smoking cessation

and weight management classes quarterly. Our Breast Health Services offer screening mammogram appointments on Saturdays for those patients who are unable to come during the weekday.

We are focused on providing quality care and healthy living options through a multitude of services that are essential for our cancer care.

JAMES B. LOCKHART, JR., M.D.

Chairman, Cancer Committee

Cancer Liaison Physician Report

In 2014, the Saint Francis Cancer Program revamped three quality improvement projects that directly impact the patient care keeping us at the forefront of quality. These include a CT screening program for patients at high risk to develop lung cancer, implementing processes and procedures for the delivery of chemotherapy to reduce medication errors and adverse drug events, and review of pathology description and coding procedures for lymphovascular invasion in breast cancer.

In an effort to identify patients with a diagnosis of lung cancer at earlier stages and with the hope of decreasing mortality, We implemented a low-dose CT lung screening program based on lung CT screening criteria according to the American Association of Thoracic Surgeons (AATS) guidelines. Currently, we are diagnosing asymptomatic patients with lung cancer at a rate of three times higher than the National Lung Trial (3.1 percent versus 1 percent).

All adult oncology inpatient and outpatient pre-printed order sets were reviewed and revised.

Several new pre-printed order sets were created to include all required elements as denoted by ASCO/ONS Chemotherapy Administration safety standards and ISMP recommendations.

Lastly, we determined that Saint Francis has a higher number of breast pathology cases coded as “unknown” since lymphovascular invasion (LVI) coding was not part of the College of American Pathologist (CAP) required elements in breast cancer. Going forward, LVI status will be collected for all invasive breast cases—pathologists have been educated about the change and will start including LVI for breast cases that meet the criteria. Cases with a date of diagnosis of August 15, 2014, or greater will be reviewed by the registrar abstracting the case. If an invasive breast case is found that does not contain an LVI evaluation, the registrar will contact the pathology department and request that a pathologist review the case. The pathology report will be amended to reflect any changes. We also identified a number of in situ cases that were erroneously coded as “unknown” for LVI and the registry abstractors have been educated on this issue.

CHARLES E. STEWART, M.D., PH.D.

Medical Director, Radiation Oncology Natalie Warren Bryant Cancer Center Saint Francis Hospital

3

Oncology Services Update

In 2014 as we continue to focus on improving access, care and services for our oncology patients, two key areas I would like to focus on are: (1) Lung Cancer Screening Program; and (2) Breast Center Services.

• refers those patients who still smoke to tobacco cessation program; and

Saint Francis Hospital has become the first and only organization in the state of Oklahoma to have a Lung Cancer Screening Program recognized by the Lung Cancer Alliance as a Center of Excellence.

Being deemed a Center of Excellence means that Saint Francis’ program meets all of the following elements:

Saint Francis Breast Center has recently implemented processes to improve timeliness of care coordination by offering the ability to have same-day biopsy services in many instances following a positive diagnostic mammogram and ultrasound. Additionally, all newly diagnosed breast cancer patients are automatically assigned to our Breast Nurse Navigator who assists with guidance, resources, coordination of care and support throughout the continuum of care.

• provides clear information on the risks and benefits of CT screening; • complies with standards based on the most up-to-date, best published practices for managing screening quality, radiation dose and diagnostic procedures; •

works collectively as a multidisciplinary team of radiologists, pathologists, pulmonologists, thoracic surgeons, oncologists, radiation oncologists and nurses needed to carry out the process of screening, diagnosis and the continuum of care;

• provides results of the screening scans to the patient or referring physician as appropriate and in a timely manner.

Thank you for the privilege to serve our patients as we strive to always extend the healing ministry of Christ.

NANCY N. THOMAS, MA, RHIA, CPHQ

Director, Oncology Service Line

Prevention and Screening Programs Offered at Saint Francis Hospital

Saint Francis offers a variety of prevention and screening programs annually to the community. Saint Francis Cancer Committee is committed to developing programs that have a direct impact on health. Our community outreach activities are dedicated to prevention and screening programs, activities that celebrate cancer survivorship and overall wellness.

2014 Prevention Programs

2014 Screening Programs

2014 Annual Community Activities

Prevention programs identify risk factors and use strategies to modify attitudes and behaviors to reduce the chance of developing cancer.

Screening programs detect cancers at an early stage improving survival.

• American Cancer Society Cattle Baron’s Ball

• American Cancer Society Resource Center Level B at Saint Francis Hospital

• American Cancer Society Relay for Life

• Annual Health Zone Health and Wellness Expo • American Cancer Society Resource Room, Level B at Saint Francis Hospital • Clear Direction* tobacco cessation classes • Point of Balance* adult weight management classes • Shapedown* children’s weight loss program * Offered several times a year at Health Zone

• Low-dose CT screening for individuals who are high risk for developing lung cancer—we are the only facility in Oklahoma that has received the Screening Center of Excellence award from the Lung Cancer Alliance for our lung cancer screening program.

• Saint Francis Breast Center offers digital screening/diagnostic mammograms and breast MRI. • Oklahoma Project Woman Mammograms allows over 400 patients annually to receive mammograms at no cost at Saint Francis Breast Center’s Yale campus or Saint Francis Broken Arrow.

• Annual Health Zone Health and Wellness Expo • Bone Marrow Transplant Survivors Event • Girl’s Night Out Wig Party • Pediatric Oncology Camp, Camp Strong • Saint Francis Health System Night with the Tulsa Drillers (Cancer Survivors Event) • Tulsa’s CureSearch Walk for the Cure of Childhood Cancer • Union Public Schools Employee Health Fair

• Screening mammograms are offered on Saturdays for patient convenience.

5

Accredited by the Commission on Cancer Since 1978

The Commission on Cancer (CoC), a program of the American College of Surgeons (ACoS), recognizes cancer care programs for their commitment to providing comprehensive, high-quality and multidisciplinary patient-centered care. Saint Francis is a Comprehensive Community Cancer Program that has been continuously accredited by the CoC since 1978. The CoC is the only multidisciplinary accreditation for cancer programs in the United States and membership is voluntary. The CoC performs an onsite survey every three years in addition to the annual requirements. During our last survey in November 2011, Saint Francis was granted a three-year Accreditation with Commendation. Our next survey is scheduled for November 2014.

Saint Francis has a dedicated multidisciplinary Cancer Committee that meets quarterly to ensure the highest quality of care is being provided to our patients. This dedicated committee sets annual goals and implements improvement projects that focus on quality of care.

Ancillary and Support Services

Ancillary Services • Hospice – The Saint Francis Hospice team provides physical, psychological, social and spiritual support to terminally ill patients and their families. It also serves as consultants for end-of-life care discussion.

• Pastoral Care – A representative from pastoral care offers the patient and their family compassionate support and an opportunity to talk and pray about the issues they are facing.

• Pharmacy – Registered pharmacists and qualified technicians provide a broad spectrum of services to the cancer patient, hospital staff and physician.

• Rehabilitative Services – The goal of acute care physical therapy focuses on maintaining or maximizing a patient’s functional independence. Therapy plans are individualized for each patient to ensure their personal needs are met.

• Social Services/Case Managers – Assistance and guidance are provided to link the patient with appropriate resources they need at the time of discharge.

Diagnostic Services • Computerized axial tomography scan (CT)

• Positron emission tomography scan (PET) • Nuclear medicine Support Services The following services are available throughout Saint Francis Health System.

• American Cancer Society resource room • Community resource coordination (transportation, financial resources) • Case management and patient navigation • Laureate Psychiatric Clinic and Hospital

• Digital radiography for mammography

• Adjustment to illness counseling

• Magnetic resonance imaging (MRI) and breast MRI

• Inpatient and outpatient treatment

• Caregiver and family counseling

2013 Multidisciplinary Cancer Conferences at Saint Francis

Saint Francis offers three multidisciplinary cancer conferences weekly. Our cancer conferences include two site-specific conferences that focus on breast and lung cancer as well as a general cancer conference for all sites. Each conference consists of a multidisciplinary team of physicians representing medical oncology, pathology, radiology, radiation oncology and surgery. Discussions include cancer stage, prognostic indicators and treatment options using evidence-based treatment guidelines. Nursing and ancillary staff also attend to provide additional support, such as financial assistance through our case management team. Our dedicated site-specific nurse navigators—Elizabeth Stewart, RN, BSN, OCN (lung cancer); and Sharon Bradley, RN (breast cancer)—work closely with the patients and physicians to ensure the highest level of patient care is provided.

In 2013, four-hundred and thirty-eight (438) cases were presented at our multidisciplinary cancer conferences.

2013 Sites Presented at Cancer Conferences

Adrenal Gland

1

Esophagus 6

Prostate 4

Anus 1

Fallopian Tube

1

Rectum 2

Appendix 1

Head and Neck

1

Salivary Gland

Bladder 1

Kidney 4

Skin 5

Bone Marrow

2

Larynx 1

Testicle 1

Brain 2

Liver 3

Thyroid 3

Breast 93

Lung 269

Unknown Primary

Cervix 1

Lymphoma 7

Uterus 2

Colon 6

Ovary 3

Vulva 1

Endometrium 4

Pancreas 1

Total

1

11

438

7

2014 Studies of Quality

In an ongoing effort to improve our patients’ quality of care, Saint Francis performs quality studies and implements improvement projects that directly impact patient care.

Quality Improvement Project #1 This project aims to improve the incidence (volume) of high-risk patients who have access to low-dose CT lung screening and meet CT lung screening criteria according to American Association of Thoracic Surgeons (AATS) guidelines in an effort to identify patients with a diagnosis of lung cancer at an earlier stage and decrease mortality.

Action Plan/Outcome: All Warren Clinic physicians provided with hand-out materials and waiting room placards with tear-off cards. Flyers provided for Warren Clinic patients and Saint Francis Health System volunteers advertising the screenings and outlining the eligibility requirements. Information about the screenings is available on Saint Francis Health System intranet (HealthNet). A lung screening enrollment protocol was developed that, if utilized by the ordering physician, allows the patient to be screened/managed per parameters of AATS

guidelines without subsequent orders; the program was opened up to all individuals meeting AATS criteria. Implementation of the CT lung screening program at Saint Francis Hospital has proven to be effective in identifying and diagnosing patients with lung cancer (asymptomatic) at a rate of three times higher than the National Lung Trial (3.1 percent versus 1 percent) in a high-risk population.

Thirty-seven point five percent of those patients diagnosed with lung cancer as a result of the screening program were diagnosed in Stage I, thus improving the likelihood of survival significantly.

Continued education and advertising to physicians and the community at large has made a significant difference in increasing the volume of patients undergoing CT lung screening.

2014 Studies of Quality,

CONTINUED

Quality Improvement Project #2 Improve patient safety and decrease the volume and severity of medication errors/adverse drug events specific to outpatient and inpatient oncology patients receiving chemotherapy.

Action Plan/Outcome: Education provided to the nurses detailing the components and timing for performing each step in an independent double-check prior to chemotherapy administration(i.e., two nurses who independently verify the current height and weight, BSA, treatment protocol, cycle number, week, day of treatment, drug, dose, concentration, preparation, infusion rate settings, patient identity and line connections before administration of chemotherapy medications). For infusion pump settings, the independent double-check should be accomplished by having the medication and pump settings readied by one individual and independently checked by a second individual (against the MAR) before administration.

Chemotherapy Administration safety standards and ISMP recommendations. Education was provided to all medical oncologists on SFH staff outlining required use of pre-printed order sets; elements of complete orders; requirements of signed chemotherapy consent with initial chemotherapy orders. Standardized pharmacy labels for chemotherapy were implemented.

Implementation of the required 2 person verification process for the following steps: (a.) complete order (all components) for correct patient; (b.) re-calculation of all doses ordered by physician to determine accuracy of dosage based upon BSA; (c.) AUC for creatinine clearance for regimens as indicated; (d.) correct medication received from pharmacy vs. order (e.) correct pump setting before “activation”. Significant progress has been made in decreasing errors, as well as severity of errors occurring after implementation of these actions for improvement

All adult oncology inpatient and outpatient pre-printed order sets were reviewed/revised and several new ones created to include all required elements as denoted by ASCO/ONS

9

2014 Studies of Quality,

CONTINUED

Quality Improvement Project #3 2012 Lymph Vascular Invasion: Breast Action Plan/Outcome: CoC Completeness Report showed 19.86 percent of Saint Francis cases were coded with a nine (nine = unknown or indeterminate). The benchmark set by the CoC for lymph vascular invasion is 20 percent. CoC Completeness Report for All Accredited Hospitals was 15.87 percent. After review, it was determined that the majority of cases coded with a nine were breast (56 cases).

Why does Saint Francis have a higher number of unknowns compared to all CoC accredited hospitals? Our largest number of cases = breast; LVI is not a required element per CAP protocol. Are cases being improperly coded? No, the abstractor is coding LVI if it is listed in the pathology report.

CAP does not have an LVI requirement for breast cases; an error cannot be determined since LVI is not part of the CAP protocol. After confirming with College of American Pathologists (CAP) that LVI is not a required element in the breast protocol the

following recommendations were made and approved by Cancer Committee: 1. Continue to use CAP protocols.

2. LVI will be collected for all invasive breast cases­—pathologists have been educated about the change and will start including LVI for breast cases that meet the criteria.

Cases with a date of diagnosis of August 15, 2014, or greater will be reviewed by the registrar abstracting the case. If an invasive breast case is found that does not contain an LVI evaluation; the registrar will contact the pathology department and request that a pathologist review the case. The pathology report will be amended to reflect any changes.

Summary by Body System, Sex, Class, Status and Best CS AJCC Stage

2013 Saint Francis Primary Site Table

Primary Site

Sex Total (%)

Stage Distribution—Analytic Cases Only

M

F

Stg 0

Stg I

Stg II

Stg III

Stg IV

88

Unk

Oral Cavity & Pharynx

54 (2.8%)

39

15

0

10

3

11

23

5

2

Tongue

24 (1.2%)

8

6

0

7

2

6

9

0

0

Salivary Glands

6 (0.3%)

3

3

0

0

1

1

4

0

0

Gum & Other Mouth

4 (0.2%)

3

1

0

1

0

0

2

0

1

Nasopharynx

2 (0.1%) 1 1 0 1 0 1 0 0 0

Tonsil

12 (0.6%)

10

2

0

1

0

3

7

0

1

Hypopharynx

1 (0.1%) 1 0 0 0 0 0 1 0 0

Other Oral Cavity & Pharynx

5 (0.3%)

3

2

Digestive System

0

0

0

0

0

5

0

352 (18.1%)

201

151

5

72

70

76

101

9

19

Esophagus

19 (1.0%)

17

2

0

4

5

6

4

0

0

Stomach

28 (1.4%)

19

9

0

8

4

6

7

0

3

Small Intestine

14 (0.7%)

9

5

0

1

3

2

5

0

3

Colon Excluding Rectum Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Splenic Flexure Descending Colon Sigmoid Colon Large Intestine, NOS

106 (5.4%) 23 1 19 6 8 4 5 29 11

48 11 1 8 4 4 1 4 10 5

58 12 0 11 2 4 3 1 19 6

3 1 0 1 0 0 0 0 1 0

13 2 0 4 0 0 0 1 6 0

22 3 1 6 1 3 1 3 2 2

36 9 0 7 3 2 1 0 11 3

29 8 0 1 2 3 1 1 8 5

1 0 0 0 0 0 0 0 0 1

2 0 0 0 0 0 1 0 1 0

Rectum & Rectosigmoid Rectosigmoid Junction Rectum

55 (2.8%) 15 40

35 8 27

20 7 13

0 0 0

16 2 14

11 3 8

17 6 11

9 4 5

0 0 0

2 0 2

Anus, Anal Canal & Anorectum

9 (0.5%)

5

4

0

1

2

4

0

1

1

Liver & Intrahepatic Bile Duct

33 (1.7%)

23

10

0

13

4

1

6

5

4

Gallbladder

3 (0.2%)

0

3

0

1

0

0

2

0

0

Other Biliary

10 (0.5%)

8

2

0

2

2

1

0

1

4

Pancreas

65 (3.3%)

34

31

2

11

17

1

34

0

0

Retroperitoneum

3 (0.2%)

1

2

0

1

0

0

2

0

0

Peritoneum, Omentum & Mesentery 6 (0.3%)

1

5

0

1

0

2

3

0

0

Other Digestive Organs

1

0

0

0

0

0

0

1

0

1 (0.1%)

11

Summary by Body System, Sex, Class, Status and Best CS AJCC Stage

2013 Saint Francis Primary Site Table

Sex

Stage Distribution—Analytic Cases Only

Primary Site

Total (%)

M

F

Respiratory System

Stg 0

Stg I

Stg II

Stg III

Stg IV

88

Unk

371 (19.0%)

195

176

6

66

34

88

162

3

8

Nose, Nasal Cavity & Middle Ear

4 (0.2%)

2

2

0

1

1

1

0

0

1

Larynx

16 (0.8%) 12 4 2 5 2 5 2 0 0

Lung & Bronchus

350 (18.0%)

180

170

4

60

31

82

160

2

7

Pleura

1 (0.1%) 1 0 0 0 0 0 0 1 0

Bones & Joints

6 (0.3%)

2

4

0

0

2

1

2

0

1

Bones & Joints

6 (0.3%)

2

4

0

0

2

1

2

0

1

Soft Tissue

11 (0.6%)

7

4

0

2

3

1

5

0

0

Soft Tissue (Including Heart)

11 (0.6%)

7

4

0

2

3

1

5

0

0

Skin Excluding Basal & Squamous 62 (3.2%)

39

23

17

23

9

3

6

1

3

Melanoma – Skin

58 (3.0%)

36

22

17

23

9

1

6

0

2

Other Non-Epithelial Skin

4 (0.2%)

3

1

0

0

0

2

0

1

1

Breast

373 (19.1%)

2

371

43

162

117

29

18

0

4

Breast

373 (19.1%)

2

371

43

162

117

29

18

0

4

Female Genital System

109 (5.6%)

0

109

1

52

12

24

20

0

0

Cervix Uteri

15 (0.8%)

0

15

0

4

4

5

2

0

0

Corpus & Uterus, NOS

51 (2.6%)

0

51

0

34

3

3

11

0

0

Corpus Uteri

49

0

49

0

34

3

3

9

0

0

Uterus, NOS

2

0

2

0

0

0

0

2

0

0

33 (1.7%)

0

33

0

8

3

15

7

0

0

Ovary Vagina

2 (0.1%) 0 2 0 2 0 0 0 0 0

Vulva

6 (0.3%)

0

6

1

3

1

1

0

0

0

Other Female Genital Organs

2 (0.1%)

0

2

0

1

1

0

0

0

0

2013 Saint Francis Primary Site Table

Sex

Primary Site

Total (%)

Stage Distribution—Analytic Cases Only

M

F

Stg 0

Stg I

Stg II

Stg III

Stg IV

88

Unk

Male Genital System

86 (4.4%)

86

0

0

14

58

8

6

0

0

Prostate

78 (4.0%)

78

0

0

9

56

7

6

0

0

Testis

7 (0.4%)

7

0

0

5

1

1

0

0

0

Penis

1 (0.1%) 1 0 0 0 1 0 0 0 0

Urinary System

145 (7.4%)

105

40

40

55

12

15

19

2

Urinary Bladder

71 (3.6%)

54

17

36

11

9

6

8

0

2 1

Kidney & Renal Pelvis

70 (3.6%)

49

21

3

44

1

9

11

1

1

Ureter

2 (0.1%) 1 1 0 0 2 0 0 0 0

Other Urinary Organs

2 (0.1%)

1

1

1

0

0

0

0

1

0

Eye & Orbit

1 (0.1%)

1

0

0

0

0

0

0

1

0

Eye & Orbit

1 (0.1%)

1

0

0

0

0

0

0

1

0

Brain & Other Nervous System

71 (3.6%)

30

41

0

0

0

0

0

71

0

Brain

31 (1.6%) 20 11 0 0 0 0 0 31 0

Cranial Nerves (Other Nervous System) 40 (2.1%)

10

30

0

0

0

0

0

40

0

Endocrine System

75 (3.9%)

15

60

0

39

8

7

4

17

0

Thyroid

56 (2.9%)

8

48

0

39

7

7

3

0

0

Other Endocrine (Including Thymus) 19 (1.0%)

7

12

0

0

1

0

1

17

0

Lymphoma

85 (4.4%)

49

36

0

11

15

19

38

1

1

Hodgkin Lymphoma

10 (0.5%)

6

4

0

0

5

3

2

0

0

Non-Hodgkin Lymphoma

1

75 (3.9%)

43

32

0

11

10

16

36

1

NHL – Nodal

62

35

27

0

10

7

15

29

0

1

NHL – Extranodal

13

8

5

0

1

3

1

7

1

0

Myeloma

27 (1.4%) 14 13 0 0 0 0 0 27 0

Myeloma

27 (1.4%) 14 13 0 0 0 0 0 27 0

13

Summary by Body System, Sex, Class, Status and Best CS AJCC Stage

2013 Saint Francis Primary Site Table

Sex

Primary Site

Total (%)

M

Stage Distribution—Analytic Cases Only F

Stg 0

Stg I

Stg II

Stg III

Stg IV

88

Unk

Leukemia

65 (3.3%) 33 32 0 0 0 0 0 65 0

Lymphocytic Leukemia

33 (1.7%) 19 14 0 0 0 0 0 33 0

Acute Lymphocytic Leukemia

22

10

12

0

0

0

0

0

22

0

Chronic Lymphocytic Leukemia

11

9

2

0

0

0

0

0

11

0 0

Myeloid & Monocytic Leukemia Acute Myeloid Leukemia Acute Monocytic Leukemia Chronic Myeloid Leukemia

30 (1.5%)

12

18

0

0

0

0

0

30

24

10

14

0

0

0

0

0

24

0

1

0

1

0

0

0

0

0

1

0

5

2

3

0

0

0

0

0

5

0

Other Leukemia

2 (0.1%) 2 0 0 0 0 0 0 2 0

Mesothelioma

5 (0.3%) 5 0 0 1 0 1 3 0 0

Mesothelioma

5 (0.3%) 5 0 0 1 0 1 3 0 0

Miscellaneous

50 (2.6%) 31 19 0 0 0 0 0 50 0

Miscellaneous

50 (2.6%) 31 19 0 0 0 0 0 50 0

Total

1,948

854 1,094

112

507

343

283

407

252

40

2013 Summary by Body System and Sex

Males

Females

Oral Cavity & Pharynx | 39 (5%)

Oral Cavity & Pharynx | 15 (1%)

Thyroid | 8 (1%)

Thyroid | 48 (4%)

Breast | 2 (1%)

Breast | 371 (34%)

Lung & Bronchus | 180 (21%)

Lung & Bronchus | 170 (16%)

Pancreas | 34 (4%)

Pancreas | 31 (3%)

Kidney & Renal Pelvis | 49 (6%)

Kidney & Renal Pelvis | 21 (2%)

Urinary Bladder | 54 (6%)

Ovary | 33 (3%)

Colon & Rectum | 83 (10%)

Urinary Bladder | 17 (2%)

Prostate | 78 (9%)

Uterine Corpus | 51 (5%)

Non-Hodgkin Lymphoma | 43 (5%)

Colon & Rectum | 78 (7%)

Melanoma of the Skin | 36 (4%)

Non-Hodgkin Lymphoma | 32 (2%)

Leukemia | 33 (3%)

Melanoma of the Skin | 22 (2%)

All Other Sites | 215 (25%)

Leukemia | 32 (3%) All Other Sites | 173 (16%)

Total All Sites | 854 (100%)

Total Cases | 1,948

Total All Sites | 1,094 (100%)

15

County at Diagnosis

Tulsa

1,031 (52.93%)

Washington

12 (0.62%) 10 (0.51%)

Wagoner

122 (6.26%)

Kay

Creek

104 (5.34%)

Latimer

Rogers

96 (4.93%)

County Unknown 7 (0.36%)

Muskogee

76 (3.90%)

Hughes

7 (0.36%)

Okmulgee

72 (3.70%)

Le Flore

7 (0.36%)

Cherokee

44 (2.26%)

Haskell

6 (0.31%)

Mayes

41 (2.10%)

Lincoln

6 (0.31%)

Pittsburg

40 (2.05%)

McCurtain

6 (0.31%)

Delaware

29 (1.49%)

Nowata

6 (0.31%)

McIntosh

27 (1.39%)

Choctaw

4 (0.21%)

Payne

26 (1.33%)

Oklahoma

4 (0.21%)

Craig

24 (1.23%)

Pushmataha

3 (0.15%)

Osage

22 (1.13%)

Noble

2 (0.10%)

Ottawa

19 (0.98%)

Coal

1 (0.05%)

Pawnee

18 (0.92%)

Garfield

1 (0.05%)

Sequoyah

18 (0.92%)

Johnston

1 (0.05%)

Adair

14 (0.72%)

Out of State

Okfuskee

14 (0.72%)

Total

8 (0.41%)

20 (1.02%) 1,948 (100.00%)

Rogers | 4.93%

Mayes | 2.10%

Delaware | 1.49%

Tulsa | 52.93%

Wagoner | 6.26%

Creek | 5.34%

Okmulgee | 3.70%

Pittsburg | 2.05%

Cherokee | 2.26%

Muskogee | 3.90%

2014 SUMMARY

Prevention and Screening Program Outcomes:

• Lung screening 183 performed with four cancer diagnoses, all referred for treatment • Oklahoma Project Woman breast screenings Saint Francis Breast Center and Saint Francis Broken Arrow performed 327 mammograms at no cost to the patient • Health Zone Point of Balance weight management program Ten participants • ShapeDown children’s weight loss program 23 participants • Saint Francis WellNow online wellness tool available online via HealthNet for employees

MISSION To extend the presence and healing ministry of Christ in all we do

VISION Saint Francis Health System will collaborate with others who share its values to be the regional leader in the delivery of quality Catholic healthcare services

VALUES Excellence Promoting high standards of service and performance Dignity Respecting each person as an inherently valuable member of the human community and as a unique expression of life Justice Advocating for systems and structures that are attuned to the needs of the vulnerable and disadvantaged and that promote a sense of community among all persons Integrity Encouraging honesty, consistency and predictability in all relationships Stewardship Ensuring prudent use of talents and resources in a collaborative manner